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health cient care system. the subcommitke under the meharg
Dental Care in the Civilian Sector
The subcommittee also believes it is important to note that in the past several years the amount of dental care available in the civilian sector has increased, both the number of programs in industry and in civil service which provide dental care as part of medical insurance or other health care programs and the amount given free under various welfare or medical care systems.
In the latter regard, the subcommittee had brought to its attention the fact that in the city of New York under the medicaid program the medical and dental care is provided free of all charges for those whose family income is $4,900 a year or less. For this program the city pays one-fourth, the State one-fourth, and the Federal Government one-half of the cost. This example was brought to the subcommittee's attention by a staff sergeant in the U.S. Army, an E-6, who pointed out that his income was only $1,200 last year. Thus, the Government in some cases is helping to support free dental care for low-income citizens whose income may be comparable with that of enlisted personnel. Recommendation
It is the conclusion of the subcommittee that the time has come for establishing a civilian-sources dental care program for dependents of active duty personnel and that further delay cannot be justified.
The subcommittee recommends in the strongest possible terms that dental care legislation be called up for hearings at the earliest practicable date.
V. EYE CARE AND RETENTION OF OPTOMETRY OFFICERS
Evidence gathered by the subcommittee indicates that dependents and retired members are having to wait increasingly long periods of time-often a matter of months—for eye examinations in military facilities.
It would appear to the subcommittee that one of the causes of this situation is the unfavorable ratio of optometry officers to patients requiring eye care.
The subcommittee found incredible inconsistencies and vast uncertainty on the part of the military services as to the requirement for optometry officers. The subcommittee found that the Army has one optometrist to every 10,000 eligible patients, the Air Force has one optometrist to every 15,000 patients, and the Navy one optometrist to every 39,000 patients.
The Department of Defense has a great propensity for avoiding making policy decisions in this area.
It would appear self-evident that staffing procedures are inadequate in one respect or another. Either the Army must be overstaffed in optometry officers or the Navy badly understaffed.
In view of the fact that the accepted standard for high quality professional care in civilian practices is a ratio of one optometrist for every 7,000 of general population, and in view of the fact that the spokesman for the Army, General Whelan, indicated that the retention of optometrists was equally as bad as retention of other medical officers, the subcommittee can only conclude that the number of optometry officers in the Navy and Marine Corps is inadequate.
It would appear that the Department of Defense has not given the services sufficient support in increasing their billets for optometrists but has, in effect, indicated that any increase in optometry officers must be achieved by reduction in other medical specialties. The subcommittee considers this an unrealistic approach.
Finally, evidence presented in the hearings indicated that the higher number of optometrists in the Army was related to the fact that the Army provides faster promotion and higher entering rank for the optometrists. In other words, the number of optometry officers is not related to the need but related to the ability to recruit.
Of the five health professions subject to the doctor draft-medicine, dentistry, osteopathy, veterinary medicine, and optometry—only one, optometry, does not receive special pay. Drafting of a limited number of optometrists has been necessary a number of times in the last sereral years.
General Hayes told the subcommittee that his office at the present time has taken the position that "special pay for optometry officers has not been indicated as a retention measure.” The Defense Depaitment position, as to why special pay is indicated for other specialties but not optometry, is that other aspects as well as occasional use of the draft must be considered, the other aspects being the degree of difficulty in procuring and retaining career optometry officers, the comparative education requirements of different professions, and income earnings in the private sector.
The subcommittee concedes that the Department of Defense optometrist problem is not nearly of the same magnitude and scope as the physician problem. But the subcommittee believes that positive action can be undertaken concerning military optometrists. The subcommittee believes that problems concerning the number of optometrists could be greatly alleviated by the enactment of special pay legislation now pending before the Committee on Armed Services. The subcommittee, therefore, recommends that the pending legislation be made the subject of hearings by a legislative subcommittee.
The subcommittee would point out that eye examinations are excluded by law under the CHAMPUS program. The representative of the largest organization of enlisted men, in recommending eye examinations be included in CHAMPUS, provided this interesting comment:
By virtue of the fact that only examinations are provided at military medical facilities and the patient must purchase glasses elsewhere, a basic cost-sharing arrangement already exists. Our recommendation would increase the beneficiary's share of the cost as he would also be paying a share of the cost of the eye examination. But he would be assured of having this service available
The subcommittee believes that the law should be changed to include eye examinations under the CHAMPUS program.
VI. OTHER PROBLEMS
The Medically Forgotten Retirees
During its hearings the subcommittee examined the question of whether any inequities result from the policies now in force regarding the eligibility for medical care of members who are retired for physical disability and who require care for certain chronic conditions.
Testimony revealed that Executive Order 10122 (April 14, 1950) as amended by Executive Order 10400 (September 29, 1952) provides essentially as follows:
1. A member retired for physical disability who completed less than 20 years of active duty and who requires treatment for chronic arthritis, malignancy, a neuropsychiatric disorder, tuberculosis, blindness and deafness requiring definitive rehabilitation, or major amputations may not obtain such treatment in a military facility. Instead, he is eligible for such care only in facilities of the Veterans' Administration.
2. A member retired for physical disability who completed 20 or more years of active duty is similarly eligible for care only in Veterans Administration facilities if he requires care for blind
ness, neuropsychiatric disorders or tuberculosis. The subcommittee is aware that the Veterans' Administration hospital system possesses a special capability with respect to the treatment of several chronic disorders referred to in the Executive order.
The subcommittee does not believe, however, that this special capability should serve as a basis for reducing the eligibility for care in military facilities of any particular group of retired members.
Gross inequities could result from the provisions of the Executive order. For example, a retired member might live within a few miles of a military facility possessing the capability of providing the care he needed. Yet, because he was retired for physical disability as opposed to length of service, he might in some instances be required to make a round trip of several hundred miles in order to obtain care in a facility of the Veterans' Administration.
The Executive order has the obvious effect of discriminating against certain members retired for disability. Generally, when any distinction is made between the benefits afforded these members who retired for physical disability and those who retired on the basis of length of service, the former are given greater benefits than the latter. The subcommittee is not aware of any benefit area other than this one where the opposite is true.
It seems clear that the Executive order should have been amended in 1956 when retired members were first given a specific statutory entitlement to space-available care in military facilities. The failure of the Department of Defense to take appropriate action at that time in order to avoid inequities appears to stem from a misinterpretation of the law (10 U.S.C. 1074(b) ) in question.
In the subcommittee's view, the authority given by the statute to the Secretaries of Defense and Health, Education, and Welfare, to issue joint regulations concerning the entitlement to care merely permits them to prescribe a detailed set of consistent instructions for implementing the law. Their regulation-issuing authority may not properly be used in a manner which has the effect of modifying the law by conditioning the entitlement of some retired members to military medical care upon a criterion other than space-availability.
The subcommittee strongly believes that the Executive order should be amended so that all retired members who are eligible for care in military facilities shall have equal eligibility for all available types of care. Short-term Health Insurance Program for Separatees
Effective on September 1, 1969, the Department of Defense established a special health insurance program for servicemen being separated from active duty other than by reason of retirement. The new program also covers dependents.
Department of Defense witnesses explained during their testimony before the subcommittee that the new program evolved from a suggestion made to the Secretary of Defense last year by the Honorable L. Mendel Rivers of South Carolina, Chairman, Committee on Armed Services.
Under present law and regulations, all health care benefits under Department of Defense-sponsored programs end, both for the serviceman and his dependents, on the day he is released from active duty, unless he is being retired. Generally, several weeks elapse before the dischargee obtains health care coverage, which usually occurs through a group plan provided by his new employer. A man being discharged who has a pregnant wife is at a particular disadvantage since most insurance companies exclude any maternity benefits during the first 10 months of coverage.
Coverage during this postservice hiatus would be provided under the new program developed by the Department of Defense in rooperation with the health insurance industry. Under the new program, servicemen have a choice between two plans, one of which is offered by Blue Cross-Blue Shield and the other by Mutual of Omaha. Both plans provide 90 days of coverage following separation. The Blue Cross-Blue Shield plan includes maternity benefits. The serviceman pays the entire cost of whichever plan he chooses. The amount he is required to pay depends upon the coverage he obtains and whethe he obtains coverage for "self" or "self and family."
The lowest charge is $16.50 for self only. For comprehensive corerage for self and family, including maternity benefits, the charge is $90. Participants in the program have the option of converting ti a regular health plan offered by Blue Cross-Blue Shield or Mutual of Omaha when their special 90-day coverage under this program ends.
The subcommittee believes this is a very worthwhile program and commends the Department of Defense for establishing it.
However, the subcommittee received information from one of the participating companies which indicates the program is not being properly administered at unit and separation activity level. The principal complaints involved improperly completed forms from separation activities, checks covering premiums without any accompanying identification of the persons whose premiums were corered, failure at the unit level to explain the program before the serviceman is sent to a separation center, and, most serious of all, failure to afford the serviceman being separated the opportunity to participate in the program.
The subcommittee recommends that the Department of Defensa take steps to assure closer supervision of program operations at the unit and separation activity level so that the full value of this most desirable program will be available to the young Americans for whom it is intended.
Subsequent to its hearings, the subcommittee learned that dissatisfaction with the manner in which separation activities were administering the program, plus the low volume of business being experienced. had led Blue Cross-Blue Shield to withdraw from this program. Since that action, in effect, ends all maternity benefits now offered under the program, the subcommittee urges the Department of Defense to immediately negotiate an agreement with other carriers who would be willing to offer this type of coverage.
HOUSE OF REPRESENTATIVES,
SUBCOMMITTEE ON SEAPOWER,
Washington, D.C., Thursday, June 25, 1970. The subcommittee met, pursuant to notice, at 10 a.m., in room 2212, Rayburn House Office Building, Hon. Charles E. Bennett, chairman of the subcommittee, presiding.
Mr. BENNETT. This morning the Seapower Subcommittee will turn its attention to the law of the sea again. This is the fifth hearing we have held on this subject. Our early hearings on March 6, 11, and 12, are classified because the executive branch had under consideration a possible position for the United States.
On May 23, the President announced his decision and position. We have asked Mr. Leigh Ratiner, chairman of the Defense Advisory Group on Law of the Sea, to return and describe the governmental position to us.
Mr. Ratiner said this can be done in open session. The first part of the meeting will be open. At the conclusion of his overall remarks on the Government position, we will go into executive session so we can go into the law of the sea.
I understand you have not been able to prepare a statement so we will appreciate your overall position on the laws of the sea.
We are happy to welcome Leigh Ratiner, chairman of the Defense Advisory Group on the Law of the Sea.
Good to see you. TESTIMONY OF LEIGH RATINER, CHAIRMAN, DEFENSE ADVISORY
GROUP ON THE LAW OF THE SEA
Mr. RATINER. Mr. Chairman, I want to introduce Captain Heg, who is the vice chairman, and Commander Lynch, who is the Navy representative on that group.
Mr. BENNETT. Glad to have you with us. Mr. RATINER. Mr. Chairman, when I appeared earlier on this subject in executive session I explained in some detail the deterioration of the law of the sea we have been witnessing in the past two decades.
What I would like to do this morning is, before describing the President's decision and the way in which it affects and protects the national security interest, I would like very quickly to summarize some of the background that I gave you at the last hearing.
Mr. BEN NETT. What you summarize is not going to be classified ?
VEPOSTED BY THE UNITED STATES OF AMERICA